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General NPI Number Information
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NPI Number | 1184338469
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Entity Type | Individual
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Provider Name | JADA RICKHEIM ARNP
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Gender | Female
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Dates
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Enumeration Date | 01/11/2023
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Last Update Date | 01/11/2023
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Provider Practice Location Address
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Address Line | 1875 N LAKEWOOD DR STE 205
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City | COEUR D ALENE
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State | ID
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Zip | 83814-4928
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Country | US
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Telephone | 208-966-4087
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Fax |
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Provider Business Mailing Address
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Address Line | 5919 W GUMWOOD CIR
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City | POST FALLS
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State | ID
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Zip | 83854-8236
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 61392728
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License Number State | WA
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